Saturday, February 11, 2012

19th Century Treatments for Insomnia

Are you having trouble sleeping?

Try some of these remedies recommended by the finest scientific and medical journals of the day.


As early as the 1880s, hydrotherapy in the form of continuous baths, showers, and wraps was used to treat patients at St. Elizabeths Hospital in Washington, DC.


Writing in the British Medical Journal, Campbell (1885) advocated Warm Douching of the Head and Neck in the Insomnia of Continued or Eruptive Fevers.


"...I wish to point out what I consider a most pleasant and soothing method of employing a douche, especially indicated in sleeplessness, and not contraindicated by cardiac debility; the proceeding is neither novel, difficult, nor disagreeable, and is productive of the best results if efficiently performed.

The patient's shoulders having been wrapped in a sheet or blanket, and his ears plugged with cotton-wool, his head is supported over the edge of the bed (a suitable vessel being placed underneath to receive the water), whilst a gentle stream of warm water from the rose-spout of an ordinary watering-pot is directed over the head and neck. The watering-pot should be held at least eighteen inches above the level of the patient's head, and the douching may be kept up for three or four minutes; the head should then be lightly dried with a towel, and the patient lifted into his ordinary position in bed. As a rule, sleep is produced within a short time."

Continuing our hydrotherapy theme, Dr. Irwin H. Hance gave a lecture to the American Climatological Association in 1899 about his conspicuously drug-free insomnia treatment:
"INSOMNIA, whether observed as a diseased condition unassociated with any other complaint or as an accompanying symptom of neurasthenia, is sufficiently often met with to warrant me in presenting to the members of this Society a short resume of my past season's work. Insomnia of itself will quickly produce this neurasthenic state, with its long list of vague nervous symptoms, and the physician is sooner or later forced to look for some form of treatment which will combat the two diseases. Most of us know how unreliable drugs are under such circumstances, first because of the uncertainty of securing a definite result, and, second, on account of the great risk run by the patient that he may contract some bad drug-habit, whereby sleep is secured at the time, but the subsequent awakening brings with it the startling realization that he is the victim of one of the enslaving drugs, to escape which he must battle harder than ever man did against the evils resulting from loss of sleep."


Hydrotherapy Tubs in Grafton State Hospital (credit: Matt Lambros).

Although also considered a treatment for neurasthenia (a 19th c. term for a type of anxiety or nervous exhaustion brought about by overwork), Hance's form of hydrotherapy was less malevolent than prolonged shower-baths for hospitalized psychiatric patients, especially those advocated by Mr. Charles Snape. Dr. Hance explained:
"In my treatment of these cases the temperature of the water is carefully regulated, so that all shock is avoided, and therein lies the secret of the success of the treatment of those who are suffering from neurasthenia or insomnia. If the temperature of the water is such as to shock them they will refuse further treatment."

A particularly interesting case study was that of a woman in her 30s who held an important position that required demanding intellectual work, which was probably unusual at the time.
CASE I.-Female, single, aged thirty-three years; United States. Insomnia alone. Occupies a position of great responsibility, requiring much mental labor and executive ability. For several months past had been sleeping less and less, until two or three hours was the limit of each night's rest. From lack of sleep was physically weak and in a general run-down condition. Physical examination of all organs and functions healthy. No symptoms of neurasthenia.

January 11, 1899. Treatment: Hot-air bath to perspiration. Needle spray, general fan douche, jet douche along spine, followed by general static electrization (positive), with local breeze along the spine. Effect of treatment felt after the third bath, sleeping longer and awakening in the morning more refreshed and stronger.

After twelve treatments, sleeping six hours nightly.

She had a relapse on Jan 27th and received additional treatments. Unfortunately, she had to stop working but later reported the cure had been lasting. Perhaps she could have just quit her job without needing hydrotherapy treatments. Wouldn't most of us sleep better without a very stressful job?




Modern hydrotherapy for the contemporary neurasthenic




Let's return to the classic insomnia treatments now. In an editorial in Science (1889), we learn about:


THE FOOD TREATMENT FOR INSOMNIA. --Dr. Eggleston says, in the journal of the American Medical Association, that most students and women who are troubled with insomnia are dyspeptic, and he has found it easy to successfully treat such cases without medicine. They are instructed to eat before going to bed, having put aside work entirely at least an hour before. If they are not hungry, they should simply be instructed to eat; and if they are hungry, they should eat whatever they want. A glass of milk and a biscuit is sometimes all that can be taken at first, or mashed potato buttered. In a short time the night appetite will grow, and the appetite will then need no particular directions. If possible, the night meal should be taken in another room than the sleeping apartment, and for men in the city it will be found advantageous to go out to a restaurant. The idea of going out for something to eat, and having to wait a short time for it, will excite the appetite. Before eating, however, a bath should be taken, preferably cold or cool, which should be given with a sponge or stiff brush, and the body thoroughly rubbed off with a coarse towel afterward. The bath need not be more than five minutes in duration. After the bathing and rubbing, or after eating, a moderate amount of exercise should be taken. For this a few minutes with Indian clubs or dumb-bells is sufficient. Further than this, the patient should go to bed at the same hour every night, and arise at the same hour every morning. There is a popular superstition that grown people should not eat immediately before going to sleep; that it will give them indigestion or nightmare, or both. Dr. Eggleston cannot see why adults should be so very different in this respect from babies.



"You remember the 90s, when everyone was pickling their own vegetables and brewing their own beer? People were growing out their mutton chops and waxing their handlebar mustaches?"

It's the Dream of the 1890s in Portland!





References

Campbell AJ. (1885). Warm Douching of the Head and Neck in the Insomnia of Continued or Eruptive Fevers. Br Med J. 1(1256):176-7.

Editors. (1889). THE FOOD TREATMENT FOR INSOMNIA. Science 14(349):254.

Hance IH. (1899). Hydrotherapy in the Treatment of Insomnia. Trans Am Climatol Assoc. 15:137-43.


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